question

[boardssuck]

I keep getting this U World question wrong...

Patient has been taking steroids for a year for her SLE. What is her cortisol, ACTH, and CRH?

So obviously CRH and ACTH are decreased...and U World says her cortisol is decreased, but isn't the exogenous steroids the same as the cortisol? I know they arent the exact same thing, but I thought I remember reading somewhere that it would lead to cortisol levels being high since it is basically the same.

PS...the girl at the table in front of me in the libes is crying! you know I have been completely stripped of all social aptitude in the last month when the only thing I thought of was "oh man, that is gonna smear her first aid notes"

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[osli]

I tend to agree, at least in as much as the question leaves a little room for ambiguity. It depends on whether you interpret 'cortisol' as "exactly" cortisol, or any glucocorticoid, or endogenous glucocorticoids, etc.

Unless in the question she abruptly quit taking the steroids, in which case everything would be low because the exogenous steroids have shut down the HPA and it takes time to recover function.

 

[BrisketAttack]

this concept bothered me, but here's the deal: the cortisol the pt is getting is not the same as cortisol. it's prednisone or some ****, which is different. therefore the endogenous steroid will be down, as well as everything else due to HPA axis supression.

 

[osli]

Yeah, literally it would have to be hydrocortisone to be exactly cortisol, and that isn't the typical steroid of choice for lupus (used for Addison's most commonly). I'd have probably chosen decreased because the question would most likely be asking about endogenous glucocorticoids anyway.